Cross Examining Psych Doctors - Tip #58-Specifying Personality Traits on Axis II

Personality traits or features are enduring patterns of perceiving, relating to and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts but are not sufficiently maladaptive to warrant concluding that the individual suffers from one of the Personality Disorders.  It is only when those traits lead to clinically significant distress or impairment in social, occupational or other important areas of functioning that it is reasonable to diagnose a Personality Disorder.  Information about personality traits is typically provided by the doctor to give the reader what they believe is significant information that will be helpful in understanding the patient.  However, since everyone has personality traits, the specification of those traits in a medical-legal report is not especially meaningful if one is concerned with using that report to determine if the person has suffered a psych injury.

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Cross Examining Psych Doctors - Tip #57-The Five Axes Diagnostic System

Doctors often provide their diagnosis using the five axes diagnostic system. Axis I is reserved for diagnosing most psychological disorders, one exception being Personality Disorders, which are diagnosed on Axis II. The reader of the report should look for Axes III, IV and V where the doctor normally provides information about the individual’s general medical conditions, psychosocial and environmental problems and levels of Global Assessment of Functioning (GAF). The GAF score is especially important in medical-legal cases since it provides information about the individual’s level of functioning that may be relevant to the court’s decisions about disability. As per the DSM, it is also important that the doctor specify an individual’s GAF score at both the time of the evaluation and the highest GAF score they obtained during the past year. 

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Cross Examining Psych Doctors - Tip #56-The MMPI Taken at Home

The MMPI-2 is the most frequently used version of the MMPI. The testing manual for the MMPI-2 provides information on the administration of the test, including the required testing conditions on pages 8 through 10 of that manual.

An inspection of page 8 of the testing manual indicates that it reads in part,

“Supervision by a fully qualified professional is essential in using the MMPI-2”

           Page 8 goes on to state,

“It is strongly recommended that the MMPI-2 not be administered without proper supervision and that it not be given to test-takers to complete at home.”

           Page 10 further emphasizes this point when it states,

“To repeat a point made earlier, administration of the MMPI-2 should always be supervised.”

Thus, when a doctor allows the patient to take the MMPI-2 at home, it is not possible to interpret any of the test data obtained as providing any credible information about the patient’s psychological status.

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Cross Examining Psych Doctors - Tip #55-Psychological Testing Standards

Of all the five sources of information that are obtained about individuals undergoing psychological evaluations, the only form of objective data that is open to public inspection and can be presented to the court is the psychological testing data. Accordingly, the manner in which those data are obtained, scored, analyzed and interpreted are of primary importance. Clearly, the first hurdle that must be overcome in assessing the credibility of the psychological testing data is the manner in which it was collected. At the very minimum, all psychological testing should be administered under the supervision of a licensed mental health professional who may employ a test proctor to monitor the psychological testing and guard against any irregularities, including the possibility that the testing was not taken by the person to whom it was intended to be administered. 

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Cross Examining Psych Doctors - Tip #54-Doctor-Created Diagnostic Ambiguity

When doctors take it upon themselves to add a modifier or specifier to their diagnosis where such a modifier or specifier is not permitted by the Diagnostic and Statistical Manual of Mental Disorders (DSM) all they have succeeded in doing is creating ambiguity in their opinions. The use of modifiers or specifiers created by the doctors results in a situation where their diagnosis is ambiguous as those creations have no generally understood meaning in DSM terminology.

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Cross Examining Psych Doctors - Tip #53-Identifying an Incomplete Major Depressive Disorder Diagnosis

In order to diagnose a Major Depressive Disorder correctly it is necessary to specify whether the disorder is of the Recurrent or Single Episode variety and to record the severity of the disorder. In Diagnostic and Statistical Manual of Mental Disorders (DSM) terminology the doctor is also required to provide a 5-digit numerical diagnostic code that allows the reader to work backwards and determine the full nature of the disorder if not described verbally. Thus, when a doctor provides a diagnosis of a Major Depressive Disorder, but declines to state if that disorder is of the Single Episode or Recurrent variety and/or declines to record the severity of the Major Depressive Disorder, then their diagnosis is incomplete.

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Cross Examining Psych Doctors - Tip #52-Deciding Between a Psychologist or a Psychiatrist for Medical-Legal Evaluations

The major differences between psychologists and psychiatrists are their training in psychological tests and psychotropic medications.  Psychologists typically have considerably more training and experience in administering and interpreting psychological tests.  Those tests are invaluable in providing data and insights into an individual’s credibility and possible psychopathology.  If you are concerned with the diagnosis of a mental disorder, the psychologist is in a better position to provide objective data concerning the person’s psychological status by using psychological tests.  However, once you know that a person has a specific disorder that is amenable or treatable with medication, the psychiatrist is the person who can intervene to provide that care.

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Fifteen Ideas That Can Drive You "Crazy"

Everyone talks to themselves.  Unfortunately, sometimes the things we say to ourselves are less than productive.  In fact, some of our internal dialogues can make us “crazy.”  Here is the fourth of the “Big Fifteen.”

     4. If something bad happens to me it's "awful."

Fifteen Ideas That Can Drive You "Crazy"

Everyone talks to themselves.  Unfortunately, sometimes the things we say to ourselves are less than productive.  In fact, some of our internal dialogues can make us “crazy.”  Here is the first of the “Big Fifteen.”

3. It is important for me to always win.

Fifteen Ideas That Can Drive You "Crazy"

Everyone talks to themselves.  Unfortunately, sometimes the things we say to ourselves are less than productive.  In fact, some of our internal dialogues can make us “crazy.”  Here is the first of the “Big Fifteen.”

2. It is important for me to be perfect

Cross Examining Psych Doctors - Tip #51-Sadness and Crying are Normal and Not Necessarily Indicative of Psychopathology

In reading medical-legal reports one frequently finds that physicians will list complaints and observations of the patient that are made during the face-to-face interview that include sadness and tearfulness.  In this regard, it should be noted that a reading of page 355 of the DSM-IV-TR and page 168 of the DSM-5 reveals that those manuals explicitly state that, “periods of sadness are inherent aspects of the human experience.” As such, any observations of sadness and related behaviors are not necessarily indicative of psychopathology.  Clearly, while it may be tempting to equate sadness, tearfulness and crying with psychopathology, it should be noted that these behaviors are well within the realm of normal human behavior and not necessarily indicative of pathology.  Individuals may cry for a variety of reasons, including being reasonably, normally, understandably, and expectably upset by physical difficulties, occupational problems and life circumstances. 

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Cross Examining Psych Doctors - Tip #48-One Thing Never to Ask a Doctor During a Depo or Trial

In cross-examining a doctor it is never a good idea to ask a question about the patient!  It is strongly recommended that all the questions you ask be directed at the doctor’s report or other medical records.  For example, instead of asking the doctor to describe what they observed that led them to conclude that the patient was suffering from a disorder they diagnosed, it is much better to ask them where in their report or their treatment notes you can find the data indicating that they made sufficient observations of the patient to warrant their diagnosis.  The reason for this is quite simple.  If you ask the doctor about the patient they can feel free to provide information not in their records that may justify some of their conclusions.  Obviously, those comments may or may not be correct for a variety of reasons. 

Check out my blog (http://drleckart.blogspot.com).  More help can be found at my website (www.drleckartwetc.com) and in my book Psychological Evaluations In Litigation: A Practical Guide for Attorneys and Insurance Adjusters

Cross Examining Psych Doctors - Tip #47-Collateral Sources of Information in Psych Reports

Collateral sources of information are found in the form of interview data collected from friends, relatives and/or co-workers or business associates of a patient undergoing a medical-legal examination.  However, only rarely are collateral sources of information available and used in evaluations for the court.  Most typically this occurs when there is some barrier to collecting data such as might occur with a person who is developmentally disabled, deceased, or who might be unable to communicate if, for example, they have suffered a severe cerebral stroke or other mentally debilitating central nervous system injury. 

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Cross Examining Psych Doctors - Tip #46-The Team Approach to Medical-Legal Evaluations

Medical-legal reports signed by the appointed physician may also be signed by a second or third physician who participated in the evaluation’s procedures. If the law has intended to have a single physician conduct a medical-legal evaluation, the use of the “team approach” may constitute a violation of the law and by itself question the substantiality and admissibility of the doctors’ report.  At the very least, the “team approach” makes it difficult to decide who to contact and who to depose in the event that there is some ambiguity in the evaluative report.

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Cross Examining Psych Doctors - Tip #45-Biofeedback

Biofeedback requires the use of biomechanical electronic transducers for measuring physical processes, which the individual tries to modify in order to achieve some psychotherapeutic effect.  It should be noted that biofeedback therapists are “certified” by private organizations such as the Biofeedback Society of California and the Biofeedback Certification Institute of America.  All biofeedback training has four common features.  First, in all biofeedback procedures the subject or patient is made aware of various physiological functions that they normally might not be conscious of, such as their heart rate or brainwaves.  Second, this awareness is produced by using various electronic instruments that provide measures of the activity of those systems.  Third, those measurements are provided as information or feedback to the subject or patient either visually, auditorily, or possibly in the tactile modality.  Fourth, the patient is instructed, asked to, or taught to control those functions under the assumption that gaining that control will alleviate psychological symptoms.  If all of these conditions have not been met then the patient has not received psychotherapeutic biofeedback training. 

Check out my blog (http://drleckart.blogspot.com).  More help can be found at my website (www.drleckartwetc.com) and in my book Psychological Evaluations In Litigation: A Practical Guide for Attorneys and Insurance Adjusters